GLAUCOMA - “The Silent Thief of Sight”
World Glaucoma Week is organised throughout the world from 10.03.2019 to 16.03.2019 and we at Dr Kodkany’s Eye Centre will be a part of spreading the awareness about Glaucoma. The main focus of this week is to eliminate blindness caused by Glaucoma and to promote the importance of regular Eye check-ups and Optic Nerve Examinations.
Glaucoma is the second leading cause of blindness in the world according to a report by The World Health Organisation and it is estimated that about 4.5 million people are affected by Glaucoma. In India, Glaucoma is one of the leading causes for blindness in patients and an estimated 1.2 million people are suffering from blindness due to Glaucoma. An extremely high percentage of patients are affected because it is can easily go undiagnosed and can only be detected in the advanced stages. It is called ‘The Silent Thief Of Sight’ as it does not produce common symptoms in its early stages. The most effective way of preventing this condition is an early diagnosis by an eye surgeon and relevant treatment options to prevent long term damage.
We would like to speak about a few points that will help you know about Glaucoma and be protected from irreversible vision loss.
1. What is Glaucoma?
Our eye consists of a watery fluid called Aqueous, that takes care of the structures present in the eye. This fluid is continuously produced in the eye and is drained out through a canal present at the edge of the Iris. When this fluid is not able to drain out, it increases the internal pressure of the eye, called Intraocular Pressure (IOP). This pressure directly affects your optic nerve, which is the leading cause of blindness.
Glaucoma presents as a painless gradual loss of vision. It has almost no symptoms in its early stages and can be detected only during an eye examination.
2. How can we detect Glaucoma ?
Glaucoma does not present any symptoms in its early stages. Hence it is imperative to consult an eye surgeon at regular intervals to keep a check on Glaucoma
In its advanced stages, Glaucoma causes considerable blindness on the peripheral vision. This is when the patient realises the presence of Glaucoma.
Some of the tests to detect Glaucoma are
Tonometry - to measure the pressure of the eye.
Gonioscopy - To look at the drainage channels within the eye.
Pachymetry - thickness of Cornea is measured
OCT - Optic Nerve Analysis
VFA -Visual Field Analysis
3. How can we prevent Glaucoma ?
As there are symptoms of Glaucoma, it is very difficult to detect in its early stages
without a thorough eye checkup
Glaucoma has a high rate of occurrence after the age of 40 and the risk increases multiple folds due to genetic factors.
The most effective way to prevent Glaucoma is to have eye check ups at regular intervals and control your Eye Pressures.
If relevant treatment is given in its early stages, the risk of blindness caused due to Glaucoma highly reduces.
4. What are the treatment options available for Glaucoma?
a. Medications
If detected in the early stages, glaucoma can be considerably controlled by the use of eye drops to reduce intraocular pressure.
b. Laser Treatment.
If the pressure cannot be controlled by medications, a laser treatment is recommended which creates an alternate route for the release of pressure
c. Trabeculectomy or Surgery.
In advanced cases, when medications fails, a flap is created to drain out the fluid from the eye. This helps to reduce the eye pressure to normal post surgery
d. Glaucoma Shunts
In rare cases, shunts are inserted into the eyes to drain out the fluid. Shunts are majorly used when all the above treatment methods are not effective to treat Glaucoma.
5. The latest developments in Glaucoma treatment
The medications and surgery procedures that we currently use for the treatment of Glaucoma have been the market for some time now and although they prove efficient in reducing the intraocular pressure, there is a need for better medications and surgery procedures to have better outcomes for Glaucoma patients. These conventional treatments reduce the pressures, create an outlet for release of aqueous humour and prevent further damage to the optic nerve.
The new developments in the market will do the work of conventional treatments as well as provide added benefits to Glaucoma patients.
A. MIGS (Minimally Invasive Glaucoma Surgery)
The main objective of any Glaucoma surgery (trabeculectomy) is to reduce the intraocular pressure by creating an alternate channel for aqeous outflow and prevent any damage to the optic nerve. Although the conventional surgeries come with a set of possible complications.
The MIGS set of operations have proved to be much safer for Glaucoma treatments with fewer complications. They use microscope sized equipments and tiny incisions
These procedures are promising treatments for Glaucoma is still a few factors about this procedure that needs to be studied for its long term benefits.
B. Medications
A few recent developments have improved the overall effectiveness of medications and added benefits to glaucoma patients.
i. Prostaglandin (PG) analogues - are a new class of ocular hypertensive drugs that are commercially available, which have been effective in treating open angle glaucoma. Latanoprost is the most commonly used and reduces the intraocular pressure by increasing the uveoscleral outflow. It does not affect the inflow of aqueous fluid. These are known to reduce the Eye Pressures by about 25-30%
Latanoprost is more effective when it is combined with other glaucoma therapies.
ii. Alpha Agonist - Brimonidine - The Alpha 2-agonists present much less complications and Brimonidine became the favoured one among treatments for Glaucoma by decreasing aqueous humor secretion and increasing uveoscleral outflow. Brimonidine has neuroprotective effects which is an important advantage over other agents in Glaucoma treatments.
iii. Brinzolamide - Brinzolamide is used to treat the high intraocular pressure that causes Glaucoma. Lowering the IOP prevents any damage to the optic nerve. This prevents blindness due to increased pressure. Brinzolamide is used to reduce the production of aqueous humor that causes the increased pressure it the eyes.
All the above medication options are relatively new compared to the conventional treatment options available for treatment of Glaucoma and are proving highly effective in preventing any further damage to your optic nerve or causing blindness.
iv. Future Treatments There are two new developments that have come to light, Aerie Pharmaceuticals Rhopressa and Bausch & Lomb/Nicox’s Vyzulta
a. Rhopressa (netarsudil ophthalmic solution 0.02%) does the work of reducing IOP better by increasing the outflow of aqueous fluid . One of the main advantages of using this would be the reduced dosage, only once a day, as compared to other drops that range to multiple times a day.
b. Vyzulta (latanoprostene bunod 0.024%) is known to do the common function of reducing the eye pressure much like all other medications but with an added function of dilating your blood vessels due to the presence of nitric oxide. This results in improved blood flow from vessels in the Optic Nerve among Glaucoma patients.
These medications provide new insights into the causes and treatment and scientists believe that they can be effective methods for treatments for Glaucoma. These medications are still under approval from the FDA as there is much research to be done to understand the long term benefits of these two.
With the developments and new techniques, Glaucoma treatments are envisioned to be safer and more effective.
NOTE: In Glaucoma, the vision loss cannot be restored to normal. Only further damage to your vision can be prevented.
For detailed information on Glaucoma please visit the section on our website
Image References
World Glaucoma Association - https://wga.one/
The International Agency for prevention of blindness - https://www.iapb.org